Bariatric Surgery in Cirrhotic Patients. Analysis of 12 cases. Nicolás Quezada MD , Cristóbal Maiz MD, Sebastián Morales MD, Sergio Guzmán MD, Ricardo Funke MD, Fernando Crovari MD, Fernando Pimentel MD, Camilo Boza MD Department of Digestive Surgery, Pontificia Universidad Católica de Chile

Disclosure Nothing to disclose.

Introduction Obesity is frequently associated with non-alcoholic fatty liver disease. The spectrum ranges from simple steatosis, non-alcoholic steatohepatitis to cirrhosis. Bariatric surgery is the most effective treatment against obesity. Nevertheless, cirrhotic patients may have higher peri-operative risks and the long-term evolution of liver disease is unknown.

Aim To report our experience in 12 cirrhotic patients who underwent bariatric surgery.

Methods Retrospective analysis of our Bariatric electronic database from January 2006 to January 2014. Description of: Cirrhosis diagnosis in relation to bariatric surgery. Liver enzymes profile progression after surgery (1-2 years). Surgical complications and surgery-associated mortality.

Results Preoperative demographic/anthropometric data N: 12 pts (out of 5306) Median or N Range Age (years) 50 35-69 Gender (female) 9 Weight (kg) 105.1 80-172 BMI (kg/m²) 40.9 32.4-53.4 Preoperative diagnosis Cirrhotic 2 Child A Non-cirrhotic 10 EGD: small esophageal varices. Abdominal US: cirrhosis morphology – splenomegaly

Results N: 12 patients Median (range) or N Type of surgery LSG 4 L-RYGB 7 O-RYGB 1 Operation time (mins) 120 (75-220) Hospital stay (days) 3 (2-6) Two patients who were recognized to have cirrhosis in the OR had a LSG instead of a LRYGB

Results N: 12 patients N Preoperative 2 Intraoperative 10 Liver biopsy Cirrhosis diagnosis N: 12 patients N Preoperative 2 Intraoperative 10 Liver biopsy 8 All were Child A

Results %EWL

Results Liver Enzymes profile progression (median) N: 12 patients Preoperative 1 year 2 years p-value* Albumin (3.5 – 4.5) 4.1 4.15 ns SGOT/AST (10-40) 55 37 28 SGPT/ALT (10-55) 78 33 Alk phosph (45-115) 140.5 121.5 113 0.05 GGT (4-50) 98 109 44 ** Total Bilirubin (0 – 1) 0.65 0.69 0.75 Direct Bilirubin (0–0.3) 0.28 0.26 INR 1.10 1.05 * p-value: Friedman Test for K nonparametric related variables ** Insufficient data for analysis

Results No peri-operative complications. No liver dysfunction after surgery. No upper GI bleeding in the long-term follow-up. One of the known cirrhotic patient developed a hepatocarcinoma – delayed OLT for 6 years. One patient died 6 years after surgery because of trauma.

Conclusions Bariatric surgery is feasible and safe in Child A cirrhotic patients with low morbidity and no mortality. Long-term evolution of liver disease after bariatric surgery is unknown, although we have not seen liver disease progression in our patients.

Bariatric Surgery in Cirrhotic Patients. Analysis of 12 cases. Nicolás Quezada MD , Cristóbal Maiz MD, Sebastián Morales MD, Sergio Guzmán MD, Ricardo Funke MD, Fernando Crovari MD, Fernando Pimentel MD, Camilo Boza MD Department of Digestive Surgery, Pontificia Universidad Católica de Chile